New Medicaid rates and new laws take effect on July 1, the start of a new state fiscal year. The new rates reflect a 2.9 percent inflationary increase in nursing and a 3.0 percent inflationary increase for specialized care. New laws for nursing facilities cover a range of issues from hospice reimbursement, truth in advertising, emergency evacuations of nursing facilities, to filing of death certificates. The Department of Social Services (DSS) recently issued a memo on the assisted living-related legislation requiring further regulatory action by the agency.

Medicaid Rates for FY 2020 – Medicaid rates for state fiscal year 2020, which begins on July 1, 2019, have been posted to the DMAS website. For nursing facilities, both the base rates (case mix neutral) and the 48 individual RUG rates can be accessed at https://www.dmas.virginia.gov/#/nursingfacilities. Specialized care rates have also been published on the same page.

On June 21 DMAS issued Medicaid Bulletin: Nursing Facility and Specialized Care Rate Updates; Fair Rental Value (FRV) Rates for New and Renovated Facilities; Institutional Hospice Reimbursement Changes Effective July 1, 2019. If you have any questions, please contact Steve Ford.

Truth in Advertising – Under HB 2219 and SB 1217 advertisers who uses information from a survey or inspection report in an ad, will be required to include in the advertisement details of the corrective action plan and the date the deficiency was corrected. Enactment of this legislation was one of VHCA-VCAL’s top priorities for 2019 to address the series of 75 attack ads placed by a Florida-based plaintiff’s firm in 38 papers across the Commonwealth in 2018. The ads were intended to solicit potential legal clients for medical malpractice cases.

Emergency Evacuation of Nursing Homes – HB 1870, HB 2451, and SB 1277 grant the State Health Commissioner authority to exempt nursing homes or hospitals from the requirement to obtain a certificate to add temporary beds to address a bed shortage elsewhere during a public health emergency when a natural or manmade disaster has caused the evacuation of nursing homes or hospitals.

This legislation will help nursing homes comply with the federal emergency preparedness regulations. Under those federal requirements, nursing homes must develop arrangements with other health care facilities to accept their residents in the event they have to limit or cease operation in an emergency. Many Virginia nursing homes and hospitals have signed the Virginia Long-Term Care Mutual Aid Plan Memorandum of Understanding (LTC MAP MOU) to satisfy this requirement. The MOU is a voluntary agreement among participants to share supplies, resources, and even house residents from other facilities when a serious need arises. A key component of the MOU requires a participating facility to have the ability to expand its bed capacity to 110 percent of its licensed bed capacity to accept residents from evacuating facilities.

Payment for Hospice Services – Under HB 1693 nursing facilities (NFs) will be able to bill the managed care organizations (MCOs) directly for the full Medicaid RUG rate associated with a resident who has elected hospice using the same billing requirements for regular Medicaid coverage. DMAS has confirmed that there are no changes to regular Medicaid NF billing to the MCO for NF care when the resident has elected hospice. Such a claim will look like a normal Medicaid “custodial” NF claim. 

DMAS has indicated to VHCA-VCAL that the direct billing will begin for dates of service on and after July 1, 2019 for all hospice residents in the managed care program, regardless of the election date. In other words, an individual under hospice care at the transition will be billed to the hospice provider for dates of service through June 30, 2019, and to the MCO for dates of service from July 1, 2019 forward.

This direct billing to the Medicaid program on and after July 1 is only in the managed care programs, not fee-for-service. NFs should still maintain relationships and contracts with the hospices for any remaining fee-for-service residents in hospice.

We are still awaiting formal confirmation of this policy via Medicaid Bulletin.

CCC Plus Hospice Update (June 6, 2019)

Hospice Billing to Change Under CCC Plus (May 2, 2019)

Electronic Death Registry System – Physicians and, if applicable, their designee(s) must register to use the Electronic Death Registry System (EDRS). EDRS enables participants in the death registration process to file death records online with the Virginia Department of Health’s Division of Vital Records (DVR), creating the option of a paperless system.

The physician in charge of the patient’s care for the illness or condition which resulted in death is primarily responsible for signing a death certificate. “In the absence of such physician or with his approval, the certificate may be completed and signed by the chief medical officer or medical director, or his designee, of the institution, hospice, or nursing home in which death occurred. More details about additional individuals who can sign a death certificate can be found in the VDH Medical Certifier Guide.

Use of EDRS will facilitate collaboration among multiple death registration users, including funeral homes, hospitals, nursing homes, physicians, medical examiners, and DVR. With the advent of the EDRS, funeral directors, physicians, and medical certifiers will be able to complete their part of the death registration process faster, with fewer errors and more efficiently.

The EDRS shall provide for the electronic registration of:

• Attended Deaths – Primary Care Provider (Green Border Death Certificate)
• Unattended Deaths – Medical Examiner (Red Border Death Certificates)
• Spontaneous Fetal Deaths – Primary Care Provider (Yellow Border Death Certificate)
• Induced Terminations of Pregnancies – Primary Care Provider (Brown Border Death Certificate)
• Donation of Bodies for Science – Virginia State Anatomical Program (VSAP)

Free training on using EDRS is available on the VDH website. In addition, all death certificates must be electronic by January 1, 2020. 

Assisted Living Bills 

The Department of Social Services (DSS) recently sent a memo to assisted living facilities (ALFs) outlining which bills require the department to adopt new regulations. In those instances, an actual effective date is to be announced.

The provisions of SB 1409 related to the assisted living administer licensing, will take effect on July 1. As of that date, an ALF must immediately notify the Board of Long Term Care Administrators and the DSS regional licensing office when an administrator dies, resigns, is discharged, or becomes unable to perform his duties. Additionally, an ALF may operate under the supervision of an acting administrator twice during any two-year period, when previously it could do so only once.

DSS has provided the following notice on the bills related to disclosure of generators, generator testing, and staffing during overnight hours: 

Notice, including an effective date, will be sent out once these requirements are updated in the assisted living facility regulation.

The process to adopt new regulations includes the opportunity for public comment. VHCA-VCAL will be closely monitoring these processes and weigh-in as necessary to provide VCAL input into the process. Read the full text of the June 12 memo from DSS.

Additional details about the legislative language is provided below. 

Disclosure of Assisted Living Generators – HB 1815 requires ALFs to disclose in writing whether the facility has an on-site emergency electrical power source for the provision of electricity during an interruption of the normal electric power supply. 

ALF Temporary Emergency Electrical Power Source – SB 1077 was amended to direct DSS to issue regulations that would require:

• ALFs with on-site emergency generators must include a description of its capacity as outlined in the emergency response plan.
• ALFs that maintain a connection for mobile generators must have agreements with vendors to provide emergency generators as well as backup agreements should the initial vendors be unable to fulfill their supply agreements during an emergency.
• ALFs must test the connection for any on-site generators at installation and then every two years; and
• ALFs must conduct monthly testing of all on-site generators and maintain records of such testing.
  

ALF Staffing During Overnight Hours – SB 1410 and HB 2521 direct the State Board of Social Services to amend regulations governing staffing of ALF units with residents who have serious cognitive impairment due to a primary psychiatric diagnosis of dementia or any other diagnosis and are unable to recognize danger or protect their own safety and welfare to create an exception to certain staffing requirements for overnight hours.

DSS must draft regulations to allow for the following number of direct care staff members be awake and on duty and responsible for the care and supervision of the residents at all times during night hours:

1. When 22 or fewer residents are present, at least two direct care staff members;
2. When 23 to 32 residents are present, at least three direct care staff members;
3. When 33 to 40 residents are present, at least four direct care staff members; and
4. When more than 40 residents are present, at least four direct care staff members plus at least one additional direct care staff member for every 10 residents or portion thereof in excess of 40 residents.

Please note that no changes are needed related to your staffing until such time as new regulations are issued.